SHORE FRONT PARKWAY ARVERNE NEW YORK 11692-1893 …

1 57-17 SHORE FRONT PARKWAY ARVERNE , NEW YORK 11692-1893 TELEPHONE: (718)634-2100 EXT. 109/ 106 APARTMENT APPLICATION HP ARVERNE Preservation Housing Company Inc. A New York City mitchell -Lama Housing Company formed under Article II of the Private Housing Finance Law of the State of New York under the supervision of Housing Preservation and Development, City of New York. Revised May 2017 MHB No. _____ Appl. No. _____ Bldg. No. _____ Apt. No. _____ No. of Rms _____ No. of Bdrms _____ Applicant Address: Name Address Zip Code Email Address Phone #: Phone #: Check One ( ): Rent Co-op Homeowner Other Explain: No. of Rooms No. of Bedrooms Monthly Rent or Carrying Charge $ Years at Present Address: If Former Site Resident Give Site Address PERSONS TO RESIDE IN APARTMENT: (Must be completed.)

2 Head of household must be 18 years of age or older.) NAME RELATIONSHIP TO HEAD OF HOUSEHOLD ** AGE * SEX * SOCIAL SECURITY NO. Apartment Size: (Select one or two sizes. Household size must meet applicable occupancy standards.) Studio (1 ppl ) 1-BR ( 2 ppl) 2-BR (3-4 ppl) 3-BR (5 -6 ppl) 4 BR (7-8 ppl) 5 BR (9 -10 ppl) SOURCES OF INCOME FOR EACH PERSON TO RESIDE IN APARTMENT: Earnings (Include Self-Employment) No. of Persons Employed NAME EMPLOYER S NAME AND ADDRESS ZIP CODE HOW LONG EMPLOYED ANNUAL EARNINGS CURRENT EST. NEXT YR $ $ $ $ $ $ DO NOT WRITE HERE Total Current Annual Earnings: $ Monthly Rent: .. $_____ INCOME OTHER THAN EARNINGS ANNUAL EARNINGS Gas & Electricity ..$_____ NAME SOURCE CURRENT EST. NEXT YR Total Charges ..$_____ $ $ MAXIMUM INCOME $ $ (A) Income Ratio: (7X) (8X).

3 $_____ $ $ (B) Median Income: _____ Persons .. $ _____ Total Current Other Earnings: $ Higher Amount of A or B ..$_____ Total Current Annual Earnings: $ Total Earnings ..$_____ Total Income from All Sources: $ Other Income ..$_____ CHECK IF DECLARING A VETERAN PREFERENCE CHECK IF VICTIM/ OR IS CURRENTLY DISPLACED DUE TO A PRESIDENTIALLY DECLARED DISASTER I certify statements made in this application have been examined by me and to the best of my knowledge and belief are true, correct and complete. I have no objection to inquiries being made for the purpose of verifying the facts herein stated. I understand that if any of the Information declared is false, my application will become void and I will lose my place on the wailing list. I further understand that the filing of this application does not in any way bind the Housing Company to reserve or assign an apartment to me.

4 Signature Date Additional Signature Lines on Reverse TOTAL INCOME ..$_____ ALLOWABLE DEDUCTIONS Secondary Wage Earner $_____ Personal Deduction for Each Household Member ..$_____ Medical and Dental Expenses As Reported on State ..$_____ Eligibility Income (Total Income Less Deductions Cannot Exceed Greater of A or B ..$_____ APPROVED (Housing Company) By: _____ Date: _____ APPROVED (Housing Preservation and Development) By: _____ Date: _____ By: _____ Date: _____ 57-17 SHORE FRONT PARKWAY ARVERNE , NEW YORK 11692-1893 TELEPHONE: (718)634-2100 EXT. 109/ 106 APARTMENT APPLICATION Spouse Date Other Family Members over 18 Date Other Family Members over 18 Date Other Family Members over 18 Date Other Family Members over 18 Date Special Requirements Please note that all applications are subject to review and approval by the housing company, credit investigation, and background check.)

5 Total household income must fall within the parameters listed below. CURRENT RENTAL RATES APARTMENT SIZE UNIT SIZE STANDARD RENT MINIMUM INCOME STUDIO 1 PERSON $1, $1, $34, 1 BEDROOM 2 PERSONS $1, -$1, $42, 2 BEDROOM 3 TO 4 PERSONS $1, $1, $49, 3 BEDROOM 5 TO 6 PERSONS $1, -$2, $54, 4 BEDROOM 7 TO 8 PERSONS $2, $2, $63, 5 BEDROOM 9 TO 10 PERSONS $2, $2, $70, FY 2017 INCOME SUMMARY HOUSEHOLD MAXIMUM INCOME 1 $53,450 2 $61,050 3 $68,700 4 $76,300 5 $82,450 6 $88,550 7 $94,650 8 $100,750 9 $101,500 10 $107,300 Please submit any changes to your application to the management office ( change of address, income or household composition). Applicants will be immediately placed on the waiting list and contacted in the order received. 57-17 SHORE FRONT PARKWAY ARVERNE , NEW YORK 11692-1893 TELEPHONE: (718)634-2100 EXT.

6 109/ 106 APARTMENT APPLICATION List of Documents that Applicant MUST bring to the leasing interview (Everything that applies to each individual household member) (ADULTS 18 AND OVER MUST BE PRESENT AT LEASING INTERVIEW) **No Charge Credit and Criminal Check Fee** Records of Earned Income (6 Current) Weekly or Biweekly Consecutive Paycheck stubs, Current Employment Verification Letter/ Non Employment Verification W-2 forms /1040 Forms for 2016 Income tax return for 2016 (state and/or federal) IRS Non-Filed Transcript if no taxes were filed for the calendar year of 2016 Records of Other Income 401K, IRA, Keogh acct., pensions and annuities latest check stub from issuing institution and/or last statement. Social security current award letter Unemployment compensation determination letter Form 2000, Form UC 30, or latest check stub SSI award letter Worker s compensation Form DOL 203, recent check stub Alimony Payment copy of court order and proof of payment Child Support Payments copy of court order and proof of payment Education scholarships/stipends award letter Trade union benefits recent check stub Welfare Benefits Original Budget Letter Veterans Benefits award letter Income from assets credit union/bank/S&L statements, etc.

7 Subsidy Voucher Section 8, LINC, TDAP, HASA Asset Information Checking Account last (6 Monthly Current/Consecutive) Bank statements Savings Account (Last Current Statement) Stock/bond certificates Certificates of deposit (Last Statement) Records of Family Circumstances/Family Composition/Allowances Marriage certificate School letter (s) for everyone enrolled Statement of disability Legal documents showing formal adoption being pursued Birth certificate(s)/ Primary residence card Photo Id for all over the age of 18 Copies of medical bills Social security cards/alternative documents Payment letters for dependent care, child care, etc.